Saturday, June 16, 2012

The Color of Humility

“Death opens a door out of a little, dark room (that's all the life we have known before it) into a great, real place where the true sun shines and we shall meet.”
C.S. Lewis, Till We Have Faces: A Novel of Cupid and Psyche 

 In the ICU we are all about control. Almost every ICU nurse I know would agree with that fact. In death there is no control. I guess that's part of what I love about palliative care. In a world where you can't beat the inevitable... at least I can have some control over how it ends... I can offer some solace at the very least. The chaos stops and there is only the person... no IV lines, no balloon pumps, no chest tubes, no monitors. Just pure nursing care. Today I am taking care of a dying patient and for some reason, today has not felt that way. There has been no solace here. It has felt exhausting and uncomfortable. There is an unease to everything about this night. I couldn't put my finger on it but as the hours have gone by I have felt it.
That gnawing feeling in my stomach. It wasn't until I saw my patient's family react to a simple question that I was able to pinpoint the source. A simple, "Do you want to be called before he passes away?" and the whole countenance changed... I saw that smile turn into a stern, furrowed brow and that pit in my stomach grew.
They think their loved one is going to recover and so until the very last breath they will force every invasive procedure possible in hopes of prolonging life. From that point on I realized why I wasn't settled and I don't know why it didn't hit me sooner. This is not end of life care...
In the ICU we are supposed to save lives and many times we do. We use our medical knowledge and nursing care to fix people up so they can live again as they once did before. But the reality is that most often life will never be the same. We have patients here who have been in our hospital for over a year. They have gotten sick and gotten better more times than I can count and in the end they usually end up succumbing to the inevitable. They die here... sometimes alone and often times after a long and painful hospital course... and I think to myself. What was it all for?
And if we can't save their life... at the very least we can make them comfortable in their last moments on this earth, right? But, what happens to the patients who are obviously dying and yet the family just isn't ready to let go yet?
It is that grey area that I find hard to handle and this patient was the epitome of all of that. We have to poke and prod until the very end. We have to do things we don't agree with and don't like. We have to face the fact that we cannot save every life and that medicine has its limits.... and I have no control here...
and I hate that.
I hate that grey area between death and life... where we have to wait and pretend it will all be okay despite what we know will inevitably come. It is in those moments where my hands are tied and I have to be the one to carry out the invasive procedures while the family is able to get the incredible, devastating courage to let their loved one go. It is in those moments where I have no control and if the only thing I can do to provide comfort to a dying man is to pray for him as I give him a bed bath and some new sheets to pass away in... well then that is what I will give.
This is the grey area of the ICU where my faults stare glaringly back at me and I am reminded of just how insignificant I am.... of just how selfish I can be. That when a family is battling with the fact of losing their father, brother, uncle, husband... all I can think is, "I hate this" It is the grey area that reminds me of how insignificant my needs are when in comparison to those of a dying man.
It is painful and uncomfortable and in the middle of all that grey it is incredibly humbling.


  1. I was reading through some of your past posts and read that you are nurse at a VA hospital...bless your heart. My dad ..who passed away quietly at home last Nov... always used the va for his care. It was ALWAYS the best! and the nurses made it so...along with the doctors. I wrote about it in one of my previous they literally made my dad a rock star and for that I will always be grateful. So when a family just can't accept things know that they still cling to hope and that soon they will realize it is time...

  2. yes, sad but its true.. we can only help and do our best.. but when death strikes... its never within our control... no one does..

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